Serious infections in patients with relapsing and progressive forms of multiple sclerosis: A German claims data study

Knapp, Rachel; Hardtstock, F.; Krieger, Julia; Wilke, Thomas; Maywald, Ulf; Chognot, Cathy; Rouzic, Erwan Muros‐Le; Craveiro, Licínio

doi:10.1016/j.msard.2022.104245

Cited by 10 publications

(10 citation statements)

References 25 publications

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“…While female MS patients had a marginally increased overall incidence of infections, severe infections were instead relatively more frequent in males. This has also been previously reported 29,35,36 and could be explained either by a more aggressive MS course in male patients or by a greater male susceptibility to severe infections regardless of disability. In any case, neither DMTs nor age were associated with incidence of severe infections in our MS cohort (apart from a numerical increase in severe infections among patients on anti-CD20).…”

Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 80%

“…There is consistent evidence for more disabled MS patients being more susceptible to infections, in particular, when severe infections are considered. 6,29,35 Accordingly, in our study, the association between EDSS and infection incidence was of greater magnitude when the analysis was restricted to grade ⩾3 infections. While female MS patients had a marginally increased overall incidence of infections, severe infections were instead relatively more frequent in males.…”

Section: Discussionmentioning

confidence: 50%

“…This finding was rather unexpected, because of most studies showing increased risk of infections as age and disability advance. 9,29,30 SARS-CoV-2 infections accounted for almost a third of all infections over the study period. This is relevant because of studies showing how occurrence of COVID-19 is influenced by social interaction patterns, fear of disease and vaccine hesitancy in both MS and general population.…”

Section: Discussionmentioning

confidence: 98%

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Interplay between age and disease-modifying treatments in influencing infection risk in multiple sclerosis

Jacober,

Disanto,

Sacco

et al. 2023

Mult Scler

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Background: Disease-modifying treatments (DMTs) can increase the risk of infections in multiple sclerosis (MS). Aged individuals are usually excluded from clinical trials, and there is uncertainty regarding safety of immunosuppressive DMTs in these patients. Objective: To investigate the association of DMTs, ageing and other clinical variables with risk of infections in MS patients. Methods: Prospective single-centre observational study collecting information on occurrence, type and grade of infections in patients followed at the MS centre, Lugano (Switzerland). Associations with infection risk were tested using multivariable Poisson and Cox regressions. Results: A total of 503 patients were included (injectables/untreated, n = 127; orals, n = 139; monoclonal antibodies (MAB), n = 237) and 326 infections recorded over 12.6 (11.6–14.0) months. As compared to injectable DMTs/no treatment, MAB and oral DMTs were positively associated with infection incidence (IRR = 2.32, 95% confidence interval (CI) = 1.39–3.89, p = 0.001; IRR = 2.04, 95% CI = 1.19–3.49, p = 0.009, respectively). After excluding COVID-19, the effect of MAB was stronger among patients <50 years (IRR = 5.90, 95% CI = 2.80–12.45, p < 0.001) than >50 years (IRR = 1.95, 95% CI = 0.91–4.15, p = 0.084). Higher disability and male sex were the only variables associated with severe infections. Conclusion: Treatment with MAB and oral DMTs is associated with higher incidence of infections, with a stronger effect in young MS patients. Disability appears the main predictor of severe infections regardless of treatment.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 98%

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Interplay between age and disease-modifying treatments in influencing infection risk in multiple sclerosis

Jacober,

Disanto,

Sacco

et al. 2023

Mult Scler

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“…Die Autoren räumen ein, dass die höheren Infektionsraten auch auf unterschiedliche Behinderungs- und Komorbiditätsmuster zurückzuführen sein könnten. Diese sind in diese Auswertung ebenso wenig eingeflossen wie die Art der DMTs 69 .…”

Section: Erhöhtes Infektionsrisiko Bei Ms?unclassified

Infektionen und Multiple Sklerose

Heidler,

Bopp,

Schwab

et al. 2024

Fortschr Neurol Psychiatr

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ZusammenfassungIn der Studienliteratur nehmen die Ursachen, Bedingungen und Folgen von Infektionen bei Patienten mit einer Multiplen Sklerose (MS) nicht den Platz ein, der ihnen von der Alltagsrelevanz her zustünde. Gerade Harnwegsinfekte und vor allem Pneumonien tragen erheblich zu Krankenhauseinweisungen, Morbidität und Mortalität bei. In dieser Übersicht werden die aktuellen Erkenntnisse zu den Infektionskrankheiten einschließlich SARS-CoV-2 bei der MS zusammengefasst. Dabei geht es um drei Fragestellungen: Beeinflussen Infektionen das MS-Risiko? Wirken sich Infektionen auf die Krankheitsaktivität bei der MS aus? Welche Effekte haben die verschiedenen immunmodulatorischen MS-Therapien auf das Risiko und den Verlauf von Infektionskrankheiten? Um die Beratung und Versorgung der MS-Patienten zu verbessern, werden die Studienlage und aktuelle Empfehlungen überprüft und erörtert, was im Behandlungsalltag zu beachten ist.

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Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis

de Seze,

Dive,

Ayrignac

et al. 2024

Neurol Ther

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The number of ageing people with relapsing multiple sclerosis (RMS) is increasing. The efficacy of disease-modifying therapies (DMTs) for RMS declines with age. Also, older persons with MS may be more susceptible to infections, hospitalisations and malignancy. Aging people with MS have higher rates of comorbidities versus aged-matched controls, increasing the individual risk of disability. We review the therapeutic properties of cladribine tablets (CladT) in ageing people with RMS, with regard to their utility for allowing these individuals to cease continuous administration of a DMT (i.e. to act as an “exit therapy”). CladT is thought to be an immune reconstitution therapy, in that two short courses of oral treatment 1 year apart provide suppression of MS disease activity in responders that far outlasts the duration of treatment and post-treatment reductions in lymphocyte counts. Post hoc analyses, long-term follow-up of populations with RMS in randomised trials, and real-world evidence suggest that the efficacy of CladT is probably independent of age, although more data in the elderly are still needed. No clear adverse signals for lymphopenia or other adverse safety signals have emerged with increasing age, although immunosenescence in the setting of age-related “inflammaging” may predispose elderly patients to a higher risk of infections. Updating vaccination status is recommended, especially against pneumococci and herpes zoster for older patients, to minimise the risk of these infections. CladT may be a useful alternative treatment for ageing people with MS who often bear a burden of multiple comorbidities and polypharmacy and who are more exposed to the adverse effects of continuous immunosuppressive therapy.

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Serious infections in patients with relapsing and progressive forms of multiple sclerosis: A German claims data study

Cited by 10 publications

References 25 publications

Interplay between age and disease-modifying treatments in influencing infection risk in multiple sclerosis

Interplay between age and disease-modifying treatments in influencing infection risk in multiple sclerosis

Infektionen und Multiple Sklerose

Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis

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